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General NPI Number Information
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NPI Number | 1245192632
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Entity Type | Organization
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Legal Business Name | CARLOS RUEDA
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 25 S REGENT ST
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City | PORT CHESTER
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State | NY
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Zip | 10573-3512
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Country | US
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Telephone | 917-972-6771
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Fax | 914-840-1281
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Provider Business Mailing Address
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Address Line | 25 S REGENT ST
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City | PORT CHESTER
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State | NY
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Zip | 10573-3512
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Country | US
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Telephone | 917-972-6771
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Fax | 914-840-1281
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CARLOS RUEDA
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Credential | MD MBA
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Telephone | 917-972-6771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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